Surgical positioning assembly and associated spinal implant device and surgical methods

ABSTRACT

The present invention provides a surgical positioning assembly that is used to place a spinal implant device or the like within an intervertebral space or the like of a patient and associated surgical methods. Advantageously, the surgical positioning assembly allows access to the implantation site to be gained along a first axis, with the implant device subsequently being placed along a second axis that is disposed at an angle or substantially perpendicular to the first axis via the actuation of the surgical positioning assembly. Thus, for example, a surgeon may use an anterior or posterior approach to place an implant device laterally, or vice versa.

CROSS-REFERENCE TO RELATED APPLICATION(S)

The present non-provisional patent application/patent claims the benefitof priority of U.S. Provisional Patent Application No. 61/033,079, filedon Mar. 3, 2008, and entitled “POSTERIOR LATERAL POSITIONING DEVICE ANDASSOCIATED IMPLANT DEVICE POSITIONING METHODS,” the contents of whichare incorporated in full by reference herein.

FIELD OF THE INVENTION

The present invention relates generally to a surgical positioningassembly that is used to place a spinal implant device or the likewithin an intervertebral space or the like of a patient and associatedsurgical methods. Advantageously, the surgical positioning assemblyallows access to the implantation site to be gained along a first axis,with the implant device subsequently being placed along a second axisthat is disposed at an angle or substantially perpendicular to the firstaxis via the actuation of the surgical positioning assembly. Thus, forexample, a surgeon may use an anterior or posterior approach to place animplant device laterally, or vice versa.

BACKGROUND OF THE INVENTION

Interbody fusion is a surgical spinal procedure that places a porousmetallic, plastic, or composite cage device and/or bone graft betweenadjacent vertebrae in the area usually occupied by an intervertebraldisc, maintaining spinal alignment and disc height. Anterior lumbarinterbody fusion (ALIF) is a spinal fusion procedure that utilizes ananterior (i.e. front) approach through the abdomen region to fuseadjacent vertebrae of the lumbar spine. Likewise, posterior lumbarinterbody fusion (PLIF) is a spinal fusion procedure that utilizes aposterior (i.e. rear) approach through the back region to fuse adjacentvertebrae of the lumbar spine. 360-degree fusion and other similarprocedures are a combination/variation of ALIF and PLIF. Theintervertebral disc is removed using appropriate rasping and graspingtools and replaced with a cage device and/or bone graft afterappropriate distraction and spacing tools are used to restore the normalheight of the intervertebral space. ALIF is preferred when either one ormultiple spinal levels are being fused and one or multipleintervertebral discs must be removed, and may be performed inconjunction with a posterior decompression (i.e. a laminectomy) and/orthe placement of stabilizing instrumentation (i.e. screws and rods,plates, etc.). Because during ALIF the spinal nerves and otherneurologic structures do not have to be retracted, wide access to theintervertebral space(s) of interest is provided without unacceptablerisk of neurologic injury. ALIF is used to treat a variety of painfulspinal conditions, such as spondylolisthesis and degenerative discdisease, among others. PLIF is also preferred when either one ormultiple spinal levels are being fused and one or multipleintervertebral discs must be removed, and may be performed inconjunction with the placement of stabilizing instrumentation (i.e.screws and rods, plates, etc.). PLIF is also used to treat a variety ofpainful spinal conditions, such as spondylolisthesis and degenerativedisc disease, among others. In either and all cases, it is oftendesirable to place an implant device laterally, that is, at an angle orsubstantially perpendicular to the anterior or posterior access axes, orvice versa.

Conventional cage devices typically include some sort of retentionmechanism to hold them securely in the intervertebral space. Suchretention mechanisms include biting and locking structures that engagethe endplate(s) of the vertebral body or bodies of interest, screwassemblies that engage the vertebral body or bodies of interest, platestructures that engage the vertebral body or bodies of interest, etc.All of these cages and retention mechanisms, however, suffer from theshortcomings that they are difficult to place, difficult to deploy,and/or tend to allow the associated cage device and/or bone graft toshift over time and thus fail to adequately maintain the normal heightof the intervertebral space, for example. Again, for these and otherreasons, it is often desirable to place an implant device laterally,that is, at an angle or substantially perpendicular to the anterior orposterior access axes, or vice versa.

BRIEF SUMMARY OF THE INVENTION

Again, in various exemplary embodiments, the present invention providesa surgical positioning assembly that is used to place a spinal implantdevice or the like within an intervertebral space or the like of apatient and associated surgical methods. Advantageously, the surgicalpositioning assembly allows access to the implantation site to be gainedalong a first axis, with the implant device subsequently being placedalong a second axis that is disposed at an angle or substantiallyperpendicular to the first axis via the actuation of the surgicalpositioning assembly. Thus, for example, a surgeon may use an anterioror posterior approach to place an implant device laterally, or viceversa.

In one exemplary embodiment, the present invention provides a surgicalpositioning assembly operable for positioning a surgical implant devicewithin an implantation site in the body of a patient through an incisionand/or portal, including: a grip operable for holding the surgicalpositioning assembly along a first axis through incision and/or portal;a retention mechanism operable for selectively coupling the surgicalimplant device to the grip and holding the surgical implant devicesubstantially along the first axis; and a pivot/rotation mechanismoperable for one or more of selectively pivoting and selectivelyrotating the surgical implant device relative to the grip until it issubstantially along a second axis that is one or more of disposed at anangle to and rotated relative to the first axis. Optionally, theretention mechanism includes one or more rod structures including one ormore of a hook structure and a saddle structure. Optionally, thesurgical implant device includes one or more bar structures thatselectively engage the one or more rod structures via the one or morehook structures and saddle structures. Optionally, the pivot/rotationmechanism includes one or more rod structures including one or more of ahook structure and a saddle structure. Optionally, the surgical implantdevice includes one or more bar structures that selectively engage theone or more rod structures via the one or more hook structures andsaddle structures. Optionally, the surgical implant device is anintervertebral cage.

In another exemplary embodiment, the present invention provides asurgical implant device for implantation within an implantation site inthe body of a patient through an incision and/or portal, including: oneor more retention structures operable for selectively coupling thesurgical implant device to a retention mechanism of a surgicalpositioning assembly and holding the surgical implant devicesubstantially along a first axis associated with the surgicalpositioning assembly; and one or more pivot/rotation structures operablefor selectively engaging a pivot/rotation mechanism of the surgicalpositioning assembly and by which the surgical implant device is one ormore of selectively pivoted and selectively rotated relative to thesurgical positioning assembly until it is substantially along a secondaxis associated with the surgical positioning assembly that is one ormore of disposed at an angle to and rotated relative to the first axis.Optionally, the retention mechanism of the surgical positioning assemblyincludes one or more rod structures including one or more of a hookstructure and a saddle structure. Optionally, the one or more retentionstructures include one or more bar structures that selectively engagethe one or more rod structures of the surgical positioning assembly viathe one or more hook structures and saddle structures. Optionally, thepivot/rotation mechanism of the surgical positioning assembly includesone or more rod structures including one or more of a hook structure anda saddle structure. Optionally, the one or more pivot/rotationstructures include one or more bar structures that selectively engagethe one or more rod structures of the surgical positioning assembly viathe one or more hook structures and saddle structures. Optionally, thesurgical implant device is an intervertebral cage.

In a further exemplary embodiment, the present invention provides asurgical method for positioning a surgical implant device within animplantation site in the body of a patient through an incision and/orportal using a surgical positioning assembly, including: disposing thesurgical positioning assembly and surgical implant device through theincision and/or portal and adjacent to the implantation site along afirst axis; actuating the surgical positioning assembly to pivot/rotatethe surgical implant device relative to the surgical positioningassembly and into the implantation site along a second axis that isdisposed one or more of at an angle to, substantially perpendicular to,and rotated with respect to the first axis; and actuating the surgicalpositioning assembly to disengage the surgical implant device from thesurgical positioning assembly.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention is illustrated and described herein with referenceto the various drawings, in which like reference numbers are used todenote like assembly/device components and/or method steps, asappropriate, and in which:

FIG. 1 is a perspective view illustrating one exemplary embodiment ofthe surgical positioning assembly and spinal implant device of thepresent invention, the surgical positioning assembly and spinal implantdevice illustrated in a disassembled state;

FIG. 2 is a partial cross-sectional view illustrating the surgicalpositioning assembly and spinal implant device of FIG. 1, the surgicalpositioning assembly and spinal implant device illustrated in anassembled, but undeployed, state;

FIG. 3 is another partial cross-sectional view illustrating the surgicalpositioning assembly and spinal implant device of FIGS. 1 and 2, thesurgical positioning assembly and spinal implant device illustrated inan assembled, and deployed, state; and

FIG. 4 is a flowchart illustrating one exemplary embodiment of thesurgical positioning assembly and spinal implant device method of thepresent invention.

DETAILED DESCRIPTION OF THE INVENTION

Again, in various exemplary embodiments, the present invention providesa surgical positioning assembly that is used to place a spinal implantdevice or the like within an intervertebral space or the like of apatient and associated surgical methods. Advantageously, the surgicalpositioning assembly allows access to the implantation site to be gainedalong a first axis, with the implant device subsequently being placedalong a second axis that is disposed at an angle or substantiallyperpendicular to the first axis via the actuation of the surgicalpositioning assembly. Thus, for example, a surgeon may use an anterioror posterior approach to place an implant device laterally, or viceversa.

Referring to FIG. 1, in one exemplary embodiment, the present inventionprovides a surgical positioning assembly 10 and a spinal implant device12. In the most broad sense, the surgical positioning assembly 10 isoperable for accessing an implantation site along a first axis, with thespinal implant device 12 subsequently being placed along a second axisthat is disposed at an angle or substantially perpendicular to the firstaxis via the actuation of the surgical positioning assembly 10. In themost narrow sense, the spinal implant device 12 is an intervertebralcage or the like and is configured and sized accordingly. However, itwill be readily apparent to those of ordinary skill in the art that thesurgical positioning assembly 12 may be used to place any suitableimplant device within any suitable implantation site, intervertebralcage or non-intervertebral cage/spinal or non-spinal, and the first andsecond axes along which access and placement are carried out may bethose associated with any suitable surgical approach, provided that thesecond axis is disposed at an angle to, substantially perpendicular to,and/or simply rotated with respect to the first axis via the actuationof the surgical positioning assembly 12.

In this exemplary embodiment, the spinal implant device 12 consists of abiocompatible structure 14 that defines a plurality of openings 15 inwhich a bone graft or the like may be placed, representing anintervertebral cage or the like. Thus, the spinal implant device 12 hasa rounded prismatic or other suitable shape, and has a thickness on theorder of millimeters to centimeters. The spinal implant device 12includes a draw bar 16 and a pivot bar 18 by which the spinal implantdevice 12 is grasped and pivoted by and relative to the surgicalpositioning assembly 10. Again, the spinal implant device 12 may includeany suitable structures by which it is grasped and pivoted and/orrotated by and relative to the surgical positioning assembly 10 upon theactuation of the surgical positioning assembly 10.

In this exemplary embodiment, the surgical positioning assembly 10consists of an annular grip 20 by which it is positioned and held in anincision site, a partially threaded rod 22 disposed through the annulargrip 20, and a draw knob 24 attached to one end of the partiallythreaded rod 22. The other end of the partially threaded rod 22terminates in a draw rod 26 and hook structure 28. The hook structure isconfigured and sized to selectively retain the draw bar 16 of the spinalimplant device 12. The surgical positioning assembly 10 also includes apivot rod 30 attached to the annular grip 20, the pivot rod 30terminating in a saddle structure 32 that is configured and sized toselectively retain the pivot bar 18 of the spinal implant device 12. Inoperation, the draw knob 24 is selectively actuated, causing thepartially threaded rod 22, the draw rod 26, and the hook structure 28 torecede towards/into the annular grip 20, thereby pulling the draw bar16. This causes the spinal implant device 12 to pivot about the pivotbar 18 disposed in the saddle structure 32, which is stationary. Thedraw knob 24 or another mechanism may be used to disengage the surgicalpositioning assembly 10 from the spinal implant device 12 once it ispivoted/rotated and placed. Again, the surgical positioning assembly 10may include any suitable structures by which it grasps and pivots and/orrotates the spinal implant device 12 upon the actuation of the surgicalpositioning assembly 10.

Referring to FIG. 2, again, the spinal implant device 12 consists of abiocompatible structure 14 that defines a plurality of openings 15 inwhich a bone graft or the like may be placed, representing anintervertebral cage or the like. Thus, the spinal implant device 12 hasa rounded prismatic or other suitable shape, and has a thickness on theorder of millimeters to centimeters. The spinal implant device 12includes a draw bar 16 and a pivot bar 18 by which the spinal implantdevice 12 is grasped and pivoted by and relative to the surgicalpositioning assembly 10.

The surgical positioning assembly 10 consists of an annular grip 20 bywhich it is positioned and held in an incision site, a partiallythreaded rod 22 disposed through the annular grip 20, and a draw knob 24attached to one end of the partially threaded rod 22. The other end ofthe partially threaded rod 22 terminates in a draw rod 26 and hookstructure 28. The hook structure is configured and sized to selectivelyretain the draw bar 16 of the spinal implant device 12. The surgicalpositioning assembly 10 also includes a pivot rod 30 attached to theannular grip 20, the pivot rod 30 terminating in a saddle structure 32that is configured and sized to selectively retain the pivot bar 18 ofthe spinal implant device 12. In operation, the draw knob 24 isselectively actuated, causing the partially threaded rod 22, the drawrod 26, and the hook structure 28 to recede towards/into the annulargrip 20, thereby pulling the draw bar 16. This causes the spinal implantdevice 12 to pivot about the pivot bar 18 disposed in the saddlestructure 32, which is stationary. The draw knob 24 or another mechanismmay be used to disengage the surgical positioning assembly 10 from thespinal implant device 12 once it is pivoted/rotated and placed.

Referring to FIG. 3, again, the spinal implant device 12 consists of abiocompatible structure 14 that defines a plurality of openings 15 inwhich a bone graft or the like may be placed, representing anintervertebral cage or the like. Thus, the spinal implant device 12 hasa rounded prismatic or other suitable shape, and has a thickness on theorder of millimeters to centimeters. The spinal implant device 12includes a draw bar 16 and a pivot bar 18 by which the spinal implantdevice 12 is grasped and pivoted by and relative to the surgicalpositioning assembly 10.

The surgical positioning assembly 10 consists of an annular grip 20 bywhich it is positioned and held in an incision site, a partiallythreaded rod 22 disposed through the annular grip 20, and a draw knob 24attached to one end of the partially threaded rod 22. The other end ofthe partially threaded rod 22 terminates in a draw rod 26 and hookstructure 28. The hook structure is configured and sized to selectivelyretain the draw bar 16 of the spinal implant device 12. The surgicalpositioning assembly 10 also includes a pivot rod 30 attached to theannular grip 20, the pivot rod 30 terminating in a saddle structure 32that is configured and sized to selectively retain the pivot bar 18 ofthe spinal implant device 12. In operation, the draw knob 24 isselectively actuated, causing the partially threaded rod 22, the drawrod 26, and the hook structure 28 to recede towards/into the annulargrip 20, thereby pulling the draw bar 16. This causes the spinal implantdevice 12 to pivot about the pivot bar 18 disposed in the saddlestructure 32, which is stationary. The draw knob 24 or another mechanismmay be used to disengage the surgical positioning assembly 10 from thespinal implant device 12 once it is pivoted/rotated and placed.

Referring to FIG. 4, in one exemplary embodiment, the surgical method 40of the present invention includes disposing the surgical positioningassembly 10 (FIGS. 1-3) and spinal implant device 12 (FIGS. 1-3) throughan incision and adjacent to the implantation site of interest along afirst axis (Block 42). Next, the surgical positioning assembly 10 isactuated to pivot/rotate the spinal implant device 12 relative to thesurgical positioning assembly 10 and into the implantation site ofinterest along a second axis that is disposed at an angle to,substantially perpendicular to, and/or simply rotated with respect tothe first axis (Block 44). Finally, the surgical positioning assembly 10is actuated to disengage the spinal implant device 12 from the surgicalpositioning assembly 10 (Block 46).

Although the present invention is illustrated and described herein withreference to preferred embodiments and specific examples thereof, itwill be readily apparent to those of ordinary skill in the art thatother embodiments and examples may perform similar functions and/orachieve like results. For example, the surgical positioning assembly ofthe present invention may be used to place any suitable implant devicewithin any suitable implantation site, cage or non-cage/spinal ornon-spinal, and the first and second axes along which access andplacement are carried out may be those associated with any suitablesurgical approach, provided that the second axis is disposed at an angleto, substantially perpendicular to, and/or simply rotated with respectto the first axis via the actuation of the surgical positioningassembly. All such equivalent embodiments and examples are within thespirit and scope of the present invention, are contemplated thereby, andare intended to be covered by the following claims.

1. A surgical positioning assembly operable for positioning a surgicalimplant device within an implantation site in the body of a patientthrough an incision and/or portal, comprising: a grip operable forholding the surgical positioning assembly along a first axis throughincision and/or portal; a retention mechanism operable for selectivelycoupling the surgical implant device to the grip and holding thesurgical implant device substantially along the first axis; and apivot/rotation mechanism operable for one or more of selectivelypivoting and selectively rotating the surgical implant device relativeto the grip until it is substantially along a second axis that is one ormore of disposed at an angle to and rotated relative to the first axis.2. The surgical positioning assembly of claim 1, wherein the retentionmechanism comprises one or more rod structures comprising one or more ofa hook structure and a saddle structure.
 3. The surgical positioningassembly of claim 2, wherein the surgical implant device comprises oneor more bar structures that selectively engage the one or more rodstructures via the one or more hook structures and saddle structures. 4.The surgical positioning assembly of claim 1, wherein the pivot/rotationmechanism comprises one or more rod structures comprising one or more ofa hook structure and a saddle structure.
 5. The surgical positioningassembly of claim 4, wherein the surgical implant device comprises oneor more bar structures that selectively engage the one or more rodstructures via the one or more hook structures and saddle structures. 6.The surgical positioning assembly of claim 1, wherein the surgicalimplant device comprises an intervertebral cage.
 7. A surgical implantdevice for implantation within an implantation site in the body of apatient through an incision and/or portal, comprising: one or moreretention structures operable for selectively coupling the surgicalimplant device to a retention mechanism of a surgical positioningassembly and holding the surgical implant device substantially along afirst axis associated with the surgical positioning assembly; and one ormore pivot/rotation structures operable for selectively engaging apivot/rotation mechanism of the surgical positioning assembly and bywhich the surgical implant device is one or more of selectively pivotedand selectively rotated relative to the surgical positioning assemblyuntil it is substantially along a second axis associated with thesurgical positioning assembly that is one or more of disposed at anangle to and rotated relative to the first axis.
 8. The surgical implantdevice of claim 7, wherein the retention mechanism of the surgicalpositioning assembly comprises one or more rod structures comprising oneor more of a hook structure and a saddle structure.
 9. The surgicalimplant device of claim 8, wherein the one or more retention structurescomprise one or more bar structures that selectively engage the one ormore rod structures of the surgical positioning assembly via the one ormore hook structures and saddle structures.
 10. The surgical implantdevice of claim 7, wherein the pivot/rotation mechanism of the surgicalpositioning assembly comprises one or more rod structures comprising oneor more of a hook structure and a saddle structure.
 11. The surgicalimplant device of claim 10, wherein the one or more pivot/rotationstructures comprise one or more bar structures that selectively engagethe one or more rod structures of the surgical positioning assembly viathe one or more hook structures and saddle structures.
 12. The surgicalimplant device of claim 7, wherein the surgical implant device comprisesan intervertebral cage.
 13. A surgical method for positioning a surgicalimplant device within an implantation site in the body of a patientthrough an incision and/or portal using a surgical positioning assembly,comprising: disposing the surgical positioning assembly and surgicalimplant device through the incision and/or portal and adjacent to theimplantation site along a first axis; actuating the surgical positioningassembly to pivot/rotate the surgical implant device relative to thesurgical positioning assembly and into the implantation site along asecond axis that is disposed one or more of at an angle to,substantially perpendicular to, and rotated with respect to the firstaxis; and actuating the surgical positioning assembly to disengage thesurgical implant device from the surgical positioning assembly.